Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis.

IF 2.8 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

European Journal of Medical Research Pub Date : 2025-04-01 DOI:10.1186/s40001-025-02498-3

Jing Wang, Xiang-Hui Li, Jiang-Quan Yu, Rui-Qiang Zheng

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引用次数: 0

Abstract

Background: The optimal red blood cell transfusion (RBCT) strategy for traumatic brain injury (TBI) patients remains a topic of debate. This systematic review and meta-analysis aimed to compare the outcomes of a liberal transfusion strategy versus a restrictive strategy in critically ill patients with TBI.

Methods: PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to November 17, 2024. We included randomized controlled trials (RCTs) of critically ill adult patients with TBI, reporting data on RBCT strategies. The outcomes included intensive care unit (ICU) mortality, long-term mortality, unfavorable functional outcomes, and the incidence of adverse events, such as transfused acute respiratory distress syndrome (TARDS) and venous thromboembolism. We also performed subgroup analyses comparing the association between disease severity and long-term mortality. This review was submitted to PROSPERO (Registration number: CRD42024558797).

Results: In the results, our analysis revealed that compared to a restrictive transfusion strategy, a liberal strategy did not significantly reduce the risk of ICU mortality (RR: 0.74; 95% CI 0.28-1.91; P = 0.53) and long-term mortality (RR: 1.02; 95% CI 0.83-1.25; P = 0.87), but it was able to reduce the risk of unfavorable functional outcomes (RR: 0.90; 95% CI 0.82-0.98; P = 0.01), although there may be a false positive error. In addition, the liberal transfusion strategy was associated with a higher incidence of Transfused Acute Respiratory Distress Syndrome (TARDS) (RR: 1.78; 95% CI 1.06-2.98; P = 0.03).

Conclusions: In critically ill patients with TBI, a liberal RBCT strategy appears to improve functional outcomes but carries the risk of false positive errors. In addition, this strategy does not seem to improve survival and may increase the risk of TARDS. Despite this, there remains insufficient evidence to recommend either strategy in this population.

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外伤性脑损伤患者的红细胞输血策略：系统回顾和荟萃分析。

背景：创伤性脑损伤（TBI）患者的最佳红细胞输血（RBCT）策略仍然是一个有争议的话题。本系统综述和荟萃分析旨在比较自由输血策略与限制输血策略在TBI危重患者中的结果。方法：检索PubMed、Web of Science、Embase和Cochrane Library，检索时间为建站至2024年11月17日。我们纳入了危重成年TBI患者的随机对照试验（rct），报告了RBCT策略的数据。结果包括重症监护病房（ICU）死亡率、长期死亡率、不良功能结局和不良事件的发生率，如输血急性呼吸窘迫综合征（TARDS）和静脉血栓栓塞。我们还进行了亚组分析，比较疾病严重程度和长期死亡率之间的关系。本综述已提交至PROSPERO（注册号：CRD42024558797）。结果：在结果中，我们的分析显示，与限制性输血策略相比，自由输血策略并没有显著降低ICU死亡风险(RR: 0.74；95% ci 0.28-1.91；P = 0.53)和长期死亡率(RR: 1.02；95% ci 0.83-1.25；P = 0.87)，但它能够降低不良功能结局的风险(RR: 0.90；95% ci 0.82-0.98；P = 0.01)，尽管可能存在假阳性误差。此外，自由输血策略与输血急性呼吸窘迫综合征（TARDS）的较高发生率相关(RR: 1.78；95% ci 1.06-2.98；p = 0.03)。结论：在危重TBI患者中，自由RBCT策略似乎可以改善功能预后，但存在假阳性错误的风险。此外，这一策略似乎并不能提高生存率，反而可能增加迟发性疾病的风险。尽管如此，在这一人群中推荐任何一种策略的证据仍然不足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Medical Research 医学-医学：研究与实验

CiteScore

3.20

自引率

0.00%

发文量

247

审稿时长

>12 weeks

期刊介绍： European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.